[HSF] Access to AV groove area post bypass Bioprosthesis choice
Macbook
grescigno at mac.com
Sun Jan 20 16:10:10 EST 2008
Dear Ani and Prasanna,
I support the idea of preserving the subvalvular apparatus but I do
not believe that this was the reason of the problems. IMHO this may
jeopardize the mid-term results with a progressive LV enlargement. In
this particular case I am quite convinced of a right heart failure.
Giuseppe
Il giorno 20/gen/08, alle ore 16:01, Ani Anyanwu ha scritto:
>> There is also no need to "excise" leaflets or more precisely
>> disrupe the> annulopapillary contnuity . In fact I may make an
>> inflammatory comment that it is> unethical not to preserve
>> annulopappillary continuity in modern day mitral> valve surgery
>>> Prasanna
> Yes Prasanna, I would say that is a rather inflammatory comment! As
> you know this chordal sparing business was largely an invention of
> Dr David in the 1980s. There is however a paper (in press) from
> David's group questioning the validity of this technique. David et
> al looked at all MVRs done over 15 years in their institution and
> found no difference in patients who had chordal sparing (these
> procedures largely done by David who is an ardent believer like
> you) vs no chordal preservation (these largely done by his
> colleagues). Of course one would have expected chordal sparing to
> do better for two reasons - because the chords were spared and
> because they were operated by one of the most talented surgeons of
> the era...yet the data showed no difference.
>
> Ani
>
>
>
>> Date: Sun, 20 Jan 2008 19:35:01 +0530> From:
>> prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com>
>> Subject: Re: [HSF] Access to AV groove area post bypass
>> Bioprosthesis choice> CC: > > Two things, I do not think a 27 size
>> valve is stenotic in an average> patient especially the one with
>> your weight and height - there must be some> other problem.> There
>> is also no need to "excise" leaflets or more precisely disrupe
>> the> annulopapillary contnuity . If you really need to do that
>> then there are> alternatives like creating artificial neochordae
>> and bivalving the PML. I> can say that I virtually do all cases
>> with annulopappillary continuity> preservation in all mitrals (and
>> have my fair share of calcified mitrals> with small LV's . In fact
>> I may make an inflammatory comment that it is> unethical not to
>> preserve annulopappillary continuity in modern day mitral> valve
>> surgery since we can always construct neochordae (these can be>
>> successfully be done with Ticron too - not necessarily Goretex)> I
>> do not know the EOA for 27 Epic can anyone give me the data). The
>> patients> BSA by Dubois formula is 1.659 m2.> What was done for
>> her Afib ?> Prasanna> > > On Jan 20, 2008 7:14 PM, Macbook
>> <grescigno at mac.com> wrote:> > > Dear Hal,> >> > I agree 100% with
>> you. However I recently operated on a very sick 76> > year-old
>> woman who had undergone a previous open heart mitral> >
>> commissurotomy for mitral stenosis. She had 80 mmHg systolic PAP
>> and> > a severe tricuspid regurg (of course), giant left and right
>> atria and> > continuous AFib. I put a 27 Epic prosthesis (the
>> european equivalent> > of Biocor) and a n° 30 MC3 tricuspid ring.
>> BTW I had to resect both> > leaflet in order to obtain this valve
>> size. She needed NO to be> > weaned from mechanical ventilation;
>> subsequently she was transferred> > to the ward but she continued
>> to show some degree of right heart> > failure (I should admit that
>> she was not managed in a perfect way and> > I did not follow the
>> patient strictly and personally as was probably> > needed....)
>> After 20 days she was retransferred to our ICU and> > reintubated
>> for severe hypercapnia (100 mmHg!). All the subsequent> > attempts
>> to wean were unsuccessful and the patient eventually died> > from
>> pneumonia. A collegue of mine said that the Epic valve was the> >
>> possible cause because of its small orifice area (the lady was 165
>> cm> > and 60 Kgms). Honestly I am not sure about his conclusion
>> but I> > should say that next time I will put a mechanical SJM
>> (she was> > already anticoagulated). I will appreciate your
>> toughts and those of> > all the members about the orifice areas of
>> Biocor/Epic prostheses and> > the possibility to create a patient/
>> prosthesis mismatch in mitral> > position.> > Thank you> >> >> >
>> Giuseppe> >> >> > Il giorno 20/gen/08, alle ore 13:14,
>> Hgrmd at aol.com ha scritto:> >> > > Dear Yadav,> > > It's nice to
>> hear a new voice on HSF. I understand your concern> > > about> > >
>> lifting the heart to inspect the CX graft in the presence of a
>> mitral> > > bioprosthesis. Excellent suggestions have been given
>> by Drs. Asai> > > and Flege. In> > > addition, I would suggest
>> that you use the smallest, lowest> > > profile bioprosthesis> > >
>> available in order to lessen the likelihood of trauma to the> > >
>> lateral wall> > > from the struts of the valve. That is why I've
>> gone to using the> > > St. Jude> > > Biocor. The height of the
>> Edwards porcine valve is 13mm, while> > > the Biocor is 9> > > mm.
>> This also reduces the likelihood of important left> > >
>> ventricular outflow> > > tract obstruction in small, hyperdynamic
>> hearts. One valve I> > > would specifically> > > avoid is the
>> Edwards Perimount. Years ago, I lost 2 patients from> > > LV wall>
>> > > rupture while using that valve. The reason is its high profile
>> as> > > well as> > > extremely sharp struts.> > >> > > Hal> > >> >
>> >> > >> > > **************Start the year off right. Easy ways to
>> stay in shape.> > > http://body.aol.com/fitness/winter-exercise?
>> NCID=aolcmp00300000002489> > >
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>> -----------------------------------------> >> > > > -- > Prasanna
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